scholarly journals Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lloyd A. C. Chapman ◽  
Margot Kushel ◽  
Sarah N. Cox ◽  
Ashley Scarborough ◽  
Caroline Cawley ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Local Community ◽  
Control Strategies ◽  
The United States ◽  
Homeless Shelters ◽  
Homeless Shelter ◽  
Cross Sectional ◽  
Symptom Screening ◽  
Exposed Individual

Abstract Background COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks. Methods We developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase chain reaction (PCR) surveys conducted during COVID-19 outbreaks in five homeless shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing. Results The proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (R0) estimates of 2.9–6.2. With moderate community incidence (~ 30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0 = 1.5), moderate-risk (R0 = 2.9), and high-risk (R0 = 6.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community. Conclusions In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.

scholarly journals Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

2020 ◽  
Author(s):  
Lloyd A.C. Chapman ◽  
Margot Kushel ◽  
Sarah N. Cox ◽  
Ashley Scarborough ◽  
Caroline Cawley ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Local Community ◽  
Control Strategies ◽  
The United States ◽  
Homeless Shelters ◽  
Homeless Shelter ◽  
Cross Sectional ◽  
Risk Environments ◽  
Symptom Screening

AbstractBackgroundMultiple COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks.MethodsWe developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase-chain-reaction (PCR) surveys conducted during COVID-19 outbreaks in five shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak in a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing and universal mask wearing.ResultsThe proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6% to 51.6%, which translated to basic reproduction number (R0) estimates of 2.9−6.2. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community. With moderate community incidence (∼30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0=1.5), moderate-risk (R0=2.9), and high-risk (R0=6.2) shelter were, respectively: 0.33, 0.11 and 0.03 for daily symptom-based screening; 0.52, 0.27, and 0.04 for twice-weekly PCR testing; 0.47, 0.20 and 0.06 for universal masking; and 0.68, 0.40 and 0.08 for these strategies combined.ConclusionsIn high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom-screening, frequent PCR testing and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be adopted to reduce outbreak risk.

scholarly journals Evaluation of a home-based 7-day infection control strategy for healthcare workers following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2): A cohort study

2020 ◽  
pp. 1-4
Author(s):  
Carla Benea ◽  
Laura Rendon ◽  
Jesse Papenburg ◽  
Charles Frenette ◽  
Ahmed Imacoudene ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Control Strategy ◽  
Healthcare Workers ◽  
Control Strategies ◽  
Risk Exposure ◽  
Nasopharyngeal Swab ◽  
Home Based ◽  
Respiratory Coronavirus ◽  
Second Wave

Abstract Objective: Evidence-based infection control strategies are needed for healthcare workers (HCWs) following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). In this study, we evaluated the negative predictive value (NPV) of a home-based 7-day infection control strategy. Methods: HCWs advised by their infection control or occupational health officer to self-isolate due to a high-risk SARS-CoV-2 exposure were enrolled between May and October 2020. The strategy consisted of symptom-triggered nasopharyngeal SARS-CoV-2 RNA testing from day 0 to day 7 after exposure and standardized home-based nasopharyngeal swab and saliva testing on day 7. The NPV of this strategy was calculated for (1) clinical coronavirus disease 2019 (COVID-19) diagnosis from day 8–14 after exposure, and for (2) asymptomatic SARS-CoV-2 detected by standardized nasopharyngeal swab and saliva specimens collected at days 9, 10, and 14 after exposure. Interim results are reported in the context of a second wave threatening this essential workforce. Results: Among 30 HCWs enrolled, the mean age was 31 years (SD, ±9), and 24 (80%) were female. Moreover, 3 were diagnosed with COVID-19 by day 14 after exposure (secondary attack rate, 10.0%), and all cases were detected using the 7-day infection control strategy: the NPV for subsequent clinical COVID-19 or asymptomatic SARS-CoV-2 detection by day 14 was 100.0% (95% CI, 93.1%–100.0%). Conclusions: Among HCWs with high-risk exposure to SARS-CoV-2, a home-based 7-day infection control strategy may have a high NPV for subsequent COVID-19 and asymptomatic SARS-CoV-2 detection. Ongoing data collection and data sharing are needed to improve the precision of the estimated NPV, and here we report interim results to inform infection control strategies in light of a second wave threatening this essential workforce.

scholarly journals Risk of COVID-19 Disease, Dialysis Unit Attributes, and Infection Control Strategy among London In-Center Hemodialysis Patients

2021 ◽  
pp. CJN.03180321
Author(s):  
Ben Caplin ◽  
Damien Ashby ◽  
Kieran McCafferty ◽  
Richard Hull ◽  
Elham Asgari ◽  
...  
Keyword(s):  
Infection Control ◽  
Local Community ◽  
Control Strategies ◽  
Event Analysis ◽  
Unit Size ◽  
Dialysis Unit ◽  
Suspected Infection ◽  
Asymptomatic Patients ◽  
Community Transmission

Background Patients receiving in-center hemodialysis treatment face unique challenges during the COVID-19 pandemic, specifically the need to attend for treatment that prevents self-isolation. Dialysis unit attributes and isolation strategies that might reduce dialysis center COVID-19 infection rates have not been previously examined. Methods We explored the role of variables including community disease burden, dialysis unit attributes (size, layout) and infection control strategies, on rates of COVID-19 among patients receiving in center hemodialysis in London, UK, between March 2nd 2020 and May 31st 2020. The two outcomes were defined as (i) a positive test for infection or admission with suspected COVID19 and (ii) admission to the hospital with suspected infection. Associations were examined using a discrete-time multi-level time-to-event analysis. Results Data on 5,755 patients, dialysing in 51 units were analysed. 990 (17%) tested positive and 465 (8%) were admitted with suspected COVID-19 between 2nd March and 31st May 2020. Outcomes were associated with age, diabetes, local community COVID-19 rates and dialysis unit size. Greater number of available side rooms and introduction of mask policies for asymptomatic patients were inversely associated with outcomes. No association was seen with sex, ethnicity, or deprivation indices nor with any of the different isolation strategies. Conclusions Rates of COVID-19 in the in center-hemodialysis population relate to individual factors, underlying community transmission, unit size and layout.

scholarly journals Which policies most effectively reduce SARS-CoV-2 transmission in schools?

2020 ◽  
Author(s):  
Anna Bershteyn ◽  
Hae-Young Kim ◽  
Jessica McGillen ◽  
R. Scott Braithwaite
Keyword(s):  
New York ◽  
Infection Control ◽  
Primary Source ◽  
The United States ◽  
Control Measures ◽  
Infection Control Measures ◽  
Symptom Screening ◽  
Local Case ◽  
Transmission Reduction ◽  
The Impact

AbstractIntroductionNew York City (NYC) has the largest public school system in the United States (US). During the SARS-CoV-2 pandemic, NYC was the first major US city to open schools for in-person learning in the 2020-2021 academic year. Several policies were implemented to reduce the risk of in-school transmission, including infection control measures (facemasks, physical distancing, enhanced indoor ventilation, cohorting of small groups, and hand hygiene), option of all-remote instruction, alternative options for how class schedules would rotate in-person and remote instruction, daily symptom screening, and testing 10-20% of students and staff weekly or monthly depending on local case rates. We sought to determine which of these policies had the greatest impact on reducing the risk of in-school transmission.MethodsWe evaluated the impact of each policy by referring to global benchmarks for the secondary attack rate (SAR) of SARS-CoV-2 in school settings and by simulating the potential for transmission in NYC’s rotating cohort schedules, in which teachers could act as “bridges” across rotating cohorts. We estimated the impact of (1) infection control measures, (2) providing an option of all-remote instruction, (3) choice of class scheduling for in-person learners, (4) daily symptom screening, (5) testing to curtail transmission, and (6) testing to identify school outbreaks. Each policy was assessed independently of other policies, with the exception of symptom screening and random testing, which were assessed both independently and jointly.ResultsAmong the policies analyzed, the greatest transmission reduction was associated with the infection control measures, followed by small class cohorts with an option for all-remote instruction, symptom screening, and finally randomly testing 10-20% of school attendees. Assuming adult staff are the primary source of within-school SARS-CoV-2 transmission, weekly testing of staff could be at least as effective as symptom screening, and potentially more so if testing days occur in the beginning of the workweek with results available by the following day. A combination of daily symptom screening and testing on the first workday of each week could reduce transmission by 70%.ConclusionsAdherence to infection control is the highest priority for safe school re-opening. Further transmission reduction can be achieved through small rotating class cohorts with an option for remote learning, widespread testing at the beginning of the work week, and daily symptom screening and self-isolation. Randomly testing 10-20% of attendees weekly or monthly does not meaningfully curtail transmission and may not detect outbreaks before they have spread beyond a handful of individuals. School systems considering re-opening during the SARS-CoV-2 pandemic or similarly virulent respiratory disease outbreaks should consider these relative impacts when setting policy priorities.

scholarly journals A cross-sectional analysis of demographic and behavioral risk factors of SARS-CoV-2 antibody positivity among a sample of U.S. college students

2021 ◽  
Author(s):  
Sina Kianersi ◽  
Christina Ludema ◽  
Jonathan T. Macy ◽  
Edlin Garcia ◽  
Chen Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Undergraduate Students ◽  
Online Survey ◽  
Control Strategies ◽  
The United States ◽  
Romantic Partners ◽  
Colleges And Universities ◽  
Behavioral Risk ◽  
Drinking Alcohol ◽  
Cross Sectional

AbstractBackgroundColleges and universities across the United States are developing and implementing data-driven prevention and containment measures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Identifying risk factors for SARS-CoV-2 seropositivity could help to direct these efforts.ObjectiveTo estimate the associations between demographic factors and social behaviors and SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 diagnostic test.MethodsIn September 2020, we randomly sampled Indiana University Bloomington (IUB) undergraduate students. Participants completed a cross-sectional, online survey about demographics, SARS-CoV-2 testing history, relationship status, and risk behaviors. Additionally, during a subsequent appointment, participants were tested for SARS-CoV-2 antibodies using a fingerstick procedure and SARS-CoV-2 IgM/IgG rapid assay kit. We used unadjusted modified Poisson regression models to evaluate the associations between predictors of both SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 infection history.ResultsOverall, 1,076 students were included in the serological testing analysis, and 1,239 students were included in the SARS-CoV-2 infection history analysis. Current seroprevalence of SARS-CoV-2 was 4.6% (95% CI: 3.3%, 5.8%). Prevalence of self-reported SARS-CoV-2 infection history was 10.3% (95% CI: 8.6%, 12.0%). Greek membership, having multiple romantic partners, knowing someone in one’s immediate environment with SARS-CoV-2 infection, drinking alcohol more than 1 day per week, and hanging out with more than 4 people when drinking alcohol increased both the likelihood of seropositivity and SARS-CoV-2 infection history.ConclusionOur findings have implications for American colleges and universities and could be used to inform SARS-C0V-2 prevention and control strategies on such campuses.

scholarly journals Estimated total cardiovascular risk in a rural area of Bangladesh: a household level cross-sectional survey done by local community health workers

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046195
Author(s):  
Mohammad Mostafa Zaman ◽  
Mohammad Moniruzzaman ◽  
Kamrun Nahar Chowdhury ◽  
Salma Zareen ◽  
AHM Enayet Hossain
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Community Health ◽  
Community Health Workers ◽  
Local Community ◽  
Health Workers ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Cvd Prevention ◽  
Very High

ObjectiveThe aim of this study was to estimate 10-year cardiovascular disease (CVD) risk among Bangladeshi rural community residents, using the 2014 WHO/International Society of Hypertension (WHO/ISH) risk prediction charts.Study designCross-sectional population-based study done by local community healthcare workers engaging the lowest level facilities of the primary healthcare system.Setting and participantsA total of 1545 rural adults aged ≥40 years of Debhata upazila of Satkhira district of Bangladesh participated in this survey done in 2015. The community health workers collected data on age, smoking, blood pressure, blood glucose and treatment history of diabetes and hypertension.Primary outcome measuresWe estimated total 10-year CVD risk using the WHO/ISH South East Asia Region-D charts without cholesterol and categorised the risk into low (<10%), moderate (10%–19.9%), high (20%–29.9%) and very high (≥30%).ResultsThe participants’ mean age (±SD) was 53.9±11.6 years. Overall, the 10-year CVD risks (%, 95% CI) were as follows: low risk (81.6%, 95% CI 78.4% to 84.6%), moderate risk (9.9%, 95% CI 7.4% to 12.1%), high risk (5.8%, 95% CI 4.4% to 7.2%) and very high risk (2.8%, 95% CI 1.5% to 4.1%). In women, moderate to very high risks were higher (moderate 12.1%, high 6.1% and very high 3.7%) compared with men (moderate 7.5%, high 5.5% and very high 1.9%) but none of these were statistically significant. The age-standardised prevalence of very high risk increased from 2.9% (0.7%–5.2%) to 8.5% (5%–12%) when those with anti-hypertensive medication having controlled blood pressure (<140/90 mm Hg) added.ConclusionThe very high-risk estimates could be used for planning resource for CVD prevention programme at upazila level. There is a need for a national level study, covering diversities of rural areas, to contribute to national planning of CVD prevention.

scholarly journals Entry Screening at Airport as a COVID-19 Surveillance Tool: Evaluation of Thiruvananthapuram International Airport in Kerala, India

2021 ◽  
Vol 9 (2) ◽  
pp. 78-83
Author(s):  
Chintha Sujatha ◽  
Sreejith Lalitha Krishnankutty ◽  
Khalid Khader ◽  
Anju K. Kanmani ◽  
Arya Rahul ◽  
...  
Keyword(s):  
Infection Control ◽  
Control Strategies ◽  
Secondary Data ◽  
Disease Spread ◽  
Chi Square ◽  
International Airport ◽  
Symptom Profile ◽  
Symptom Screening ◽  
Public Health Authorities ◽  
Chi Square Test

Introduction: As part of coronavirus disease 2019 (COVID-19) control strategies, entry screening was established at International airports. An assessment of the screening system will inform decision-making for improving entry screening for infectious diseases. Methods: Assessment of entry screening at Thiruvananthapuram international airport done during pre and post-lockdown phases. Observation, interviews, and secondary data analysis were the methods employed. The number of passengers screened, their symptom profile, the yield of screening, actions taken, staff pattern, perceptions, training, and infection control practices assessed. Chi-square test and t test were used for testing significance. Results: Out of the 46139 passengers screened pre-lockdown, 297 (0.64%) had symptoms, 23 (0.05%) were positive in thermal screening. Six (2%) among them tested positive for COVID-19. Out of the 44263 passengers screened post lockdown, from May to July 2020, 671 (1.5%) were symptomatic, and 12 (0.03%) were positive in thermal screening. COVID-19 was confirmed in 45 (6.7 %) patients identified through the screening. With the surge in cases, the proportion of passengers opting for institutional quarantine increased significantly (P<0.001). None of the staff contracted the disease. Infection control practices followed by them were optimal. Conclusion: Though the yield of thermal and symptom screening is low, entry screening is an opportunity to identify travelers at risk of COVID-19 infection. In addition, it helps in raising awareness to ensure quarantine and guides public health authorities in preventing disease spread to the community.

scholarly journals Congregate Shelter Characteristics and Prevalence of Asymptomatic SARS-CoV-2

2020 ◽  
Author(s):  
Elizabeth A. Samuels ◽  
Rebecca Karb ◽  
Rahul Vanjani ◽  
M. Catherine Trimbur ◽  
Anthony Napoli
Keyword(s):  
Rhode Island ◽  
A Priori ◽  
Mitigation Strategies ◽  
Homeless Shelters ◽  
Infection Prevalence ◽  
Multicenter Cohort Study ◽  
Cross Sectional ◽  
Symptom Screening ◽  
Increased Risk ◽  
Sleeping Arrangements

AbstractBackgroundIndividuals experiencing homelessness residing in congregate shelters have increased risk for SARS-CoV-2 infection. Prevalence of asymptomatic SARS-CoV-2 in congregate shelters is high, but shelter characteristics associated with SARS-CoV-2 transmission are currently unknown.MethodsWe conducted a cross-sectional, multicenter cohort study across five congregate shelters in Rhode Island. We tested people 18 years of age and older staying in Rhode Island congregate shelters in April 2020 during the COVID-19 pandemic. A survey instrument was designed and implemented based on an a priori sample size. All consented participants reported basic demographics, recent travel, duration of time at the shelter, any symptomatology, and had their temperature and pulse oximetry measured. Each participant was tested for COVID-19 using nasopharyngeal swabbing. Shelter characteristics about location, occupancy, resident length of stay, and COVID-19 mitigation strategies were collected through structured phone questionnaire with shelter staff.ResultsA total of 302 individuals were screened and 299 participated across five homeless shelters. The median age was 47.9 (range 18-85) and 20% were female. Of the 299 participants, 35 (11.7%) were positive for SARS-CoV-2; rates varied among shelters, ranging from 0% to 35%. Among the participants in the study, 5% had a new cough, 4% shortness of breath, and 3% reported loss of taste or smell. Symptom prevalence did not vary significantly between positive and negative SARS-CoV-2 groups. Regular symptom screening was not associated with lower infection rates. Shelters with higher rates of positivity were in more densely populated areas, cared for a more transient populations, and instituted fewer social distancing practices for sleeping arrangements or mealtimes.Conclusions and RelevanceResidents of congregate shelters are at increased risk for asymptomatic transmission of SARS-CoV-2. To reduce transmission and enable continuation of low-threshold shelter services, there is a need for universal testing, implementation of infection control and physical distancing measures within congregate shelters, and expansion of non-congregate supportive housing.

Dietary Behavior and Predicted 10-Year Risk for a First Atherosclerotic Cardiovascular Disease Event Using the Pooled Cohort Risk Equations Among US Adults

2016 ◽  
Vol 32 (6) ◽  
pp. 1447-1451 ◽  
Author(s):  
Meghan K. Edwards ◽  
Elizabeth Crush ◽  
Paul D. Loprinzi
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Task Force ◽  
Dietary Behavior ◽  
Heart Association ◽  
The United States ◽  
Healthy Eating Index ◽  
Healthy Diet ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cross Sectional

Purpose: The pooled cohort equations were developed in 2013 by the American College of Cardiology/American Heart Association Task Force to predict an individual’s 10-year risk of an atherosclerotic cardiovascular disease (ASCVD) event. The purpose of the present study was to evaluate how predicted 10-year ASCVD event risk varies as a function of daily dietary behavior. Design: Cross-sectional. Setting: National Health and Nutrition Examination Survey 2003 to 2006. Participants: A total of 2362 adults aged 40 to 79 years. Measures: The ASCVD was assessed via the pooled cohort equations, with the Healthy Eating Index calculated from self-reported dietary behavior. Analysis: Multivariable linear and logistic regression. Results: Adults in the United States consuming a healthy diet (vs those not consuming a healthy diet) had an 88% increased odds of being at low risk for a future ASCVD event within the next 10 years (odds ratio [OR] = 1.88; 95% confidence interval [CI]: 1.35-2.68; P < .001). Similarly, those eating a healthy diet had a 44% reduced odds of being at high risk for a future ASCVD event within the next 10 years (OR = 0.56; 95% CI: 0.34-0.93; P = .02). Conclusion: Among adults who were free of cardiovascular disease, those with a healthy diet had reduced odds of being at high risk for a 10-year ASCVD event.

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